Inspection on 09/01/07 for St Davids

This inspection was carried out on 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Davids 30/12/08

St Davids 21/02/06

St Davids 07/10/05

St Davids 20/12/04

St Davids 14/06/04

St Davids 10/03/04

Similar services:

Clouds House

Clouds House

Closereach

Closereach

Chandos House

Chandos House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 St Davids 50 Walliscote Road Weston Super Mare North Somerset BS23 1XF Lead Inspector Unannounced Key Inspection 9th &11th January 2007 11:30 St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Davids Address 50 Walliscote Road Weston Super Mare North Somerset BS23 1XF 01934 412967 01934 620575 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered mangement (if applicable) Type of registration No. of places registered (if applicable) Western Counselling Services Limited Dr William Kenrick Evans Care Home 12 Category(ies) of Past or present alcohol dependence (12), Past or registration, with number present drug dependence (12) of places St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 12 persons aged 17 - 64 years Date of last inspection 21st February 2006 Brief Description of the Service: Western Counselling Services is registered with the Commission for Social Care Inspection (CSCI) and provides primary and secondary programmes of rehabilitation for up to 65 people between the ages of 17 and 64 years who have alcohol and/or drug dependencies. The bulk of the primary counselling programme takes place at a day centre and there are two houses (Meijer and St Davids), which provide accommodation for mixed sex groups on primary programmes. St Davids provides up to twelve places. Three other houses, Larkhill, Kintyre and Clarence Park Lodge provide accommodation for single sex groups receiving secondary programmes. The counselling is based upon the twelve-step Minnesota model. These homes have a private arrangement with a local GP practice to provide medical support and assessments, especially for those who are in the initial part of the primary programme. The fees for the home are negotiable with the funding authority. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. St Davids is a house designated for male service users in the primary stage of the programme, and may have residents who are following a medically assisted withdrawal from addictive substances. The unannounced key inspection of St Davids took place with the inspector and the managing director, Amanda Lea. The first part of the inspection process involved reviewing documentation at the administrative headquarters of Western Counselling Services. The inspector then made a site visit to the home. At the time of the visit there were 8 people in residence. The majority of the residents and the housekeeper were spoken with; the registered manager was also available as was one of the counsellors who worked with the service users at St Davids. The inspector gathered evidence for the report from the residents, staff, and documentation held at the home, and from the eleven responses to the service questionnaire sent to service users by the Commission prior to the inspection. The home has been assessed as providing a good level of service What the service does well: St Davids provides a primary care treatment programme for those addicted to drugs or alcohol or with eating disorders. The residents there are supported on a 24 hour basis by the staff team of support workers and counsellors. The accommodation, whilst communal, is of a reasonable quality and there are a variety of facilities available for personal care. The home is well maintained, and the handyman deals with any issues requiring attention. The residents confirmed that they were able to raise any concerns and speak directly to staff or other residents in order to find a resolution. The residents had been at the home for varied lengths of time, but generally were positive about the house and support received particularly from the housekeeper. The staff team are well established and secure in their knowledge of the client group and patterns of behaviour exhibited as people move through the programme. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient information available to support informed choice. EVIDENCE: The admissions officer has the initial contact with people wishing to move into St Davids, and have a good knowledge base about the opportunities the programme offers people to rehabilitate from addiction. All the residents have an assessment undertaken prior to admission, which covers all aspects of their life including any mental health issues. It is from this information that a decision is made by the management to offer a place on the programme. The inspector raised the question of how the registered person demonstrates that the home can meet needs of referred potential residents. The current situation is that potential residents are informed by letter however the registered manager /person do not always sign the letter. This must be reviewed as the registered person has responsibility for accepting suitable service users onto the programme. The residents currently at St Davids were able to tell the inspector that they had a choice of service, however Western Counselling Services were chosen either because of the personal recommendation, either from care managers or from people who had already been through the programme. The individual contracts for residents who are on licence from prison or have Drug Testing Treatment Orders were available to the inspector. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 9 St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are reviewed regularly and focus on developing residents self help skills. EVIDENCE: Care plan documentation for all the residents at the home was available and included admission assessments, individual care plans, progress documented on daily records and other information relating to the residents’ progression through the programme i.e. peer group feedback. Notes are well written, and files are tidy and well organised. Risk assessments are limited and could be expanded to include triggers which may lead to relapse. Individual choice and decision making is subject to the limitations of the programme, however, all the residents stated they were treated as individuals and supported as such. The residents in primary care have a very different view of the programme than those in secondary care. The strict routine and house rules do require a period of adjustment, which varies with the individual. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 11 Within the home there are personal choices made about meals etc, and all residents can leave the programme if they wish to. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported to identify their goals and work to achieve them. EVIDENCE: The programme is abstinence based and has strict limitations on personal freedom. The house rules ensure that the group stay together for example they all walk to the day centre together and adhere to the rules about use of home entertainment equipment. The weekly programme is very full and allows time for therapeutic duties and for completion of written work by residents. The activity time allowed is limited with community activity sessions on the weekend only. The residents were able to talk about the disciplined routine and the system for warning people for breaking house rules or not working effectively within the programme. The system of verbal and written warnings can lead to discharge, and has done so for some residents. The group stated that there was an immediate effect to them in that it made them realise how easy it is to leave, and that more effort is required to work through the programme and remain St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 13 abstinent. The residents were in agreement that the mindset needed was to concentrate on your own recovery, be supportive of others, but not to let this influence you. The inspector met with the housekeeper for the home and discussed the meals on offer, and was able to observe that alternatives were offered and provided to the residents. The housekeeper had worked at Western Counselling Services for a number of years and had trained as a counsellor. This enables her to be supportive of the residents at St Davids house, whilst understanding the programme and the effect of abstinence on individuals after a long period of using drugs and alcohol. The residents praised the food, its quantity and quality and reaffirmed to the inspector that options were always be available to them. The residents also appreciated the support from the housekeeper who was very approachable and always had time to listen to them. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to health and remedial services; the home has an efficient medication policy. EVIDENCE: None of the residents currently at St Davids requires support with personal care. All the residents require support through the programme, which is provided through counselling on a one-to-one basis and through group therapy. The house rules dictate that residents are well groomed and wear clean clothing in order to develop their personal-care skills and their sense of respect of themselves and towards their peers. Some of the residents have health care needs which require external appointments such as hospital treatment, these needs are assessed on admission and local services accessed when necessary. The service users are supported to achieve optimum health and well-being, the home provides within the programme additional groups such as music therapy and provide in subjects such as maintaining good health with sessions on relapse prevention. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 15 Since the last inspection the home have introduced new policies and procedures relating to the management of medicines. Staff who have responsibility to administer medication have completed a training course. The medication system was reviewed with the home manager; Nomad trays are used for regular medication, these are supplied by the chemist and administered by staff. The requirements made by the pharmacy inspector in respect of storage and record keeping for medication had been met. The home was advised to keep short courses of medication in their original containers and not transfer them to a Nomad tray as this would be considered to be secondary dispensing and may result in errors. The medicines used to assist residents’ to withdraw from drugs/alcohol are stored at the doctor’s surgery and supplied to the home already dispensed into Nomad trays. The inspector noted that the labelling on the trays gave insufficient detail and should include the number and strength of medication, as well as a description of the tablets in the tray. The MAR sheet should also be signed by the doctor to indicate they have prescribed the dosage marked on the sheet. The manager stated that he would ensure that these recommendations and requirements were put into place. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation has a robust complaints procedure, which is widely available. EVIDENCE: There is a complaints procedure in place at St Davids for residents to use. The residents stated they were able to raise concerns directly with the staff at the home, and were happy with their response. All the staff receive training in abuse awareness and have references and CRB checks completed prior to starting work. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is in keeping with the type of service provided. EVIDENCE: The inspector toured the St Davids with the Amanda Lea. The home is in a good state of repair with adequate funds allocated for maintenance. The grounds are small but there is access to outside space. The accommodation for the residents is comfortable and efforts have been made to ensure that bed linen matches and that each resident has sufficient space. All of the bedrooms are shared, but were very clean and tidy. St Davids employs a housekeeper who is appreciated by the residents and does good job, the residents also support maintaining the homes’ cleanliness through therapeutic duties. The management of the home ensure that there is ongoing decoration and refurbishment to ensure that the home is clean and safe for the residents. The communal accommodation has natural light; the residents are able to smoke in the lounge, however there is no outside venting extractor in the room St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 18 to remove the smoke. At the front of the house is a busy main road and the lounge was quite noisy, it should be possible to consider secondary glazing to reduce traffic noise. The residents appeared to be satisfied with the physical environment of the home, stating that they had everything they needed to be comfortable. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff within the organisation receives relevant training that is targeted and focused on improving outcomes for residents. EVIDENCE: The staff all have individual files which contains evidence of a good recruitment process. All staff have relevant qualifications and provide evidence of this through certification. There are references and CRB checks taken up on all employees prior to them commencing work at St Davids. The management was able to provide the inspector with a staff rota, which demonstrated that there are sufficient staff, support workers, counsellors and ancillary, to maintain the support for residents over a 24-hour basis. The management also provided individual staff records of training; the courses attended by staff were role specific and enhanced the skill mix and experience of the staff team. The staff are supported in various ways, i.e. feedback sessions after therapy groups. The staff receive individual supervision for personal development and St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 20 training, supervision is given by an outside agency for counsellors, and individual staff groups have staff meetings. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is proactive in seeking residents views and improving the service for the future. EVIDENCE: The registered manager for the home Dr Ken Evans is very experienced and continues to work closely with the residents in the primary stages of the programme. He also takes responsibility for the counselling support for the day centre. The managing director, Amanda Lea, takes responsibility for the quality assurance, budget management, training and staff supervision for St Davids. The central administration office also deals with the financial accounts and building maintenance. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 22 There is a stable staff team with 24 hour support should it be needed. The outcomes for the residents were stated to be very positive because of the supportive atmosphere and open approachable style adopted at the home. There is a degree of informality however this is underpinned by the house rules. Some of the residents admitted to challenging the house rules, but were aware that they were in place for their own best interests and to safeguard their progress through the programme. The residents were very satisfied with their service, and felt able to recommend the service to other people. Minutes for staff meetings are held at the organisation’s administrative office. The quality assurance carried out at the home includes collation of information relating to retention rates, service user satisfaction and completion rates. The home also holds regular reunions, which are well attended and give an indicator to the success of the programme. Amanda Lea is undertaking regulation 26 visits and reports are currently sent to the commission with a copy being held by the organisation. Amanda Lea undertakes the monthly audits of the home. Other audits for areas such as the buildings and provision of domestic services are undertaken by the managers responsible for these areas. Currently a business plan for the forthcoming year is being formulated. There were no health and safety concerns at the home at the time of the inspection, although it was mentioned that the extractor fan at the day centre was broken and the room was full of cigarette smoke. St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 11/01/07 arrangements for the recording and safe handling of medicines received into the care home. The labelling on the Nomad trays is in insufficient detail and should include the number and strength of medication, as well as a description of the tablets in the tray. The organisation, in respect of 11/10/07 cigarette smoking, shall ensure that any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated by employing suitable ventilation systems in areas where smoking is permitted. The registered person shall make 11/01/07 arrangements for the recording and safe handling of medicines received into the care home. The MAR sheet should also be signed by the doctor to indicate they have prescribed the dosage marked on the sheet. Requirement 2. YA42 13(4)(c) 23(2)(p) 3. YA20 13 (2) St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations Risk assessments should identify potential risks and possible triggers that may cause relapse or disciplinary discharge. The assessments should outline strategies for safeguarding the health and welfare of service users after discharge. The registered person shall make arrangements for the recording and safe handling of medicines received into the care home. Short term medication i.e. antibiotics must be dispensed from their original container. 2. YA20 St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Davids DS0000008107.V323446.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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